Bike to Save Lives!
Five Boro Bike Tour Team Application 2014
Charitable Spots
Thank you for your interest in biking for organ, eye, and tissue donation. Your support
makes a difference as we work together to save lives. Please note the fundraising
minimum is $750 tax deductible. Deadline to apply is March 31, 2014.
Please submit application to Karen Cummings at kcumming@nyodn.org or by fax to
(646)291-4600.
First Name ________________________________ Last Name____________________________________
Birthday (mm/dd/yr) ____ /____ / _____
Address _______________________________________________________________________________
City _______________________________________ State______________________________________
Telephone Number (home) _____________________________ (cell) ______________________________
Preferred Email Address __________________________________________________________________
Have you ever biked long distance before? _______YES ________ NO
If yes, what is the longest distance? __________________________________________________
How did you learn about these available spots? ________________________________________________
What is your connection, if any, to organ, eye, and tissue donation? _______________________________
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Why would you like to bike for organ, eye, and tissue donation?
___________________________________
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_______________________________________________________________________________________
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If you are selected to be a member of the team what will your personal fundraising goal be?
_______________________________________________________________________________________
(Minimum required is $750)
Terms and Conditions:
Fundraising Commitment: Each biker must raise a minimum of $750. Each biker will be supplied with a
team jersey and biking shorts. In the event that you do not meet the fundraising minimum by May 1,
2014 New York Organ Donor Network reserves the right to charge the balance owed to your credit card,
unless prior arrangements have been made. A credit card authorization form must be completed once
the participant is accepted to the team.
Participant Requirements: Each member of Team Donate Life is required to complete the following
activity:
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Complete and submit -NYODN Team Donate Life Team application (This document).
Wear Team Donate Life bike uniform on May 4, 2014 Race Day
Participate in a team photo either prior to or on the day of the race.
Promote Team Donate Life using their social media (Facebook, Twitter and Instagram).
Participate in any potential media (print, TV or online) opportunities about Team Donate Life.
Attend one team activity before the ride on May 4, 2014.
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If you are interested in other ways to promote Team Donate Life and organ donation please contact
Karen Cummings at kcumming@nyodn.org.
Use of Funds: Funds raised will support the New York Organ Donor Network’s public education programs
for organ, eye, and tissue donation. The New York Organ Donor Network is a non-profit, tax exempt 501c3
and a federally designated organ procurement organization, incorporated under Section 402 of the Notfor-Profit Corporation Law of the State of New York. All contributions made to the New York Organ Donor
Network are fully tax deductible according to the laws that govern charitable giving.
Cancellation Policy: You many cancel your participation in the Five Boro Bike Tour within 48 hours of
confirming your participation with New York Organ Donor Network. To do so you must contact Karen
Cummings (kcumming@nyodn.org) at New York Organ Donor Network in writing on or before the
cancellation date. After 48 hours, you are responsible for raising the $750 minimum requirement for
fundraising. There are no allowable exclusions for any reason to the fundraising minimum requirement
including injury resulting in an inability to bike the 2014 TD Five Boro Bike Tour.
Donations raised and received by New York Organ Donor Network will not be refunded, even if you
leave the team before May 4, 2014.
Team Selection: Submission of this application does not guarantee selection for Team Donate Life. Each
applicant will be notified of team selection no later than April 5, 2014 for additional questions, please
contact Karen Cummings at (646) 291-4454.
I agree to the terms and conditions above:
Signature: ___________________________________________________________________________
Print Name: __________________________________________________________________________
Date: ________________________________________________________________________________
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